Aspirin after mini-stroke dramatically reduces further risk

London: Taking aspirin immediately after minor strokes could substantially reduce the risk of major strokes in patients who have minor ‘warning’ events, a team of European researchers has found.

Writing in the journal Lancet, the researchers said that immediate self-treatment with aspirin when patients experience stroke-like symptoms would considerably reduce the risk of major stroke over the next few days.

Aspirin is already given to people who have had a stroke or transient ischaemic attack (TIA — often called a ‘mini-stroke’) to prevent further strokes after they have been assessed in hospital and in the longer-term, reducing the subsequent stroke risk by about 15 percent.

However, based on a previous study, the team suspected that the benefits of more immediate treatment with aspirin could be much greater.

“The risk of a major stroke is very high immediately after a TIA or a minor stroke (about 1,000 times higher than the background rate), but only for a few days,” said lead researcher Peter Rothwell, stroke expert from the University of Oxford.

The team revisited the individual patient data from twelve trials (about 16,000 people) of aspirin for long-term secondary prevention — that is, to prevent a further stroke — and data on about 40,000 people from three trials of aspirin in treatment of acute stroke.

They found that almost all of the benefit of aspirin in reducing the risk of another stroke was in the first few weeks, and that aspirin also reduced the severity of these early strokes.

Rather than the 15 percent overall reduction in longer-term risk reported previously in these trials, aspirin reduced the early risk of a fatal or disabling stroke by about 70-80 percent over the first few days and weeks.

“Our findings confirm the effectiveness of urgent treatment after TIA and minor stroke – and show that aspirin is the most important component. Immediate treatment with aspirin can substantially reduce the risk and severity of early recurrent stroke,” Rothwell said.

“This finding has implications for doctors, who should give aspirin immediately if a TIA or minor stroke is suspected, rather than waiting for specialist assessment and investigations,” Rothwell noted.